OBJECTIVES: This study examined whether patients' race was associated with their families' being approached for organ donation and agreeing to donation. METHODS: Logistic regression models were applied to data collected from records at 112 hospitals. RESULTS: The odds that a family of a White patient was approached for donation were nearly twice those for a family of an African American. The odds of donation also differed by race, but the magnitude varied by patient and hospital characteristics. CONCLUSIONS: Much attention directed toward racial disparity in donation has focused on attitudes of the public. The behavior of hospital staff also may be related to differences in rates.